What causes fibromyalgia pain—and how can it be treated?

It can be hard living with fibromyalgia. In addition to persistent pain, the chronic condition often causes symptoms like fatigue, mental fogginess (brain fog), and digestive issues. It may also be difficult to diagnose and treat, which can add to the challenge.

While scientists don’t know exactly what causes fibromyalgia, they’re learning how pieces of the puzzle fit together. And having a better understanding of the disease can lead to faster diagnosis, more effective treatment, and ultimately, a better quality of life.

With that in mind, learn how brain chemicals, sleep patterns, stress—and more—could factor into fibromyalgia, plus newer avenues for treatment.

Even though fibromyalgia pain can be quite severe when a tender point is pressed, healthcare providers (HCPs) typically find no evidence of inflammation or tissue damage in these areas when they examine them further. Instead, it’s widely believed the issue lies in the way the brain and spinal cord process pain. This may involve certain genes that can make seemingly ordinary sensations feel overwhelmingly intense. 

It could also involve substance P, a chemical messenger that amplifies pain signals. Some research suggests that people with fibromyalgia have more substance P in their blood than those without the condition.

It’s well established that chronic stress can lead to headaches, a sour stomach, and sleep problems. But some researchers think severe stress may also trigger fibromyalgia. 

According to a 2020 review published in Expert Review of Neurotherapeutics, many people with fibromyalgia also meet the criteria for post-traumatic stress disorder (PTSD). This is perhaps because similar, overreactive mechanisms may be at play in pain disorders such as fibromyalgia and stress disorders like PTSD. Emotional trauma may also change the brain in ways that trigger fibromyalgia symptoms.

Another clue about fibromyalgia’s origins comes from the medications used to treat the disease. Many were originally designed to quiet the brain activity that leads to seizures in people with epilepsy. Certain antidepressants are also useful for fibromyalgia, even in people who don’t have depression. 

Researchers believe these medications work by raising levels of brain chemicals like serotonin and norepinephrine—chemical messengers that are well-known for their mood effects but that also help regulate pain. Boosting their levels can reduce pain for some people with fibromyalgia.

Because researchers think abnormal brain activity may play a role in fibromyalgia, some are investigating therapies that aim directly at the brain—not with drugs, but with a dose of electricity.

In transcranial magnetic stimulation (TMS), an electromagnetic coil is placed on someone’s scalp, and an electric current is passed through it. This creates a small electric current in the part of the brain right under the coil. TMS has been used for treatment-resistant depression, but studies show it may also reduce pain. People with fibromyalgia who received TMS experienced a noticeable reduction in pain symptoms for six weeks after their final session, according to one 2022 meta-analysis published in the journal Pain Medicine.

Researchers have noticed another thing: People with fibromyalgia share some characteristics with people who have obstructive sleep apnea (OSA), a condition that makes them momentarily stop breathing during sleep, sometimes hundreds of times a night. OSA leaves people exhausted and more sensitive to pain. 

One of the most common treatments for OSA is continuous positive airway pressure (CPAP), which uses a mask to gently blow air into nasal passages to keep the airways open during sleep. Can this help treat fibromyalgia? Research is ongoing, but some case reports have found that fibro symptoms eased when people with the condition used CPAP.

Scientists are finding more clues about how best to treat fibromyalgia, but to benefit as much as possible from this growing understanding, it’s critical to work with the right healthcare provider (HCP). Whether you suspect you have fibromyalgia or have already been diagnosed, look for a knowledgeable HCP who has experience with the condition and understands its treatments. A family physician, internist, or rheumatologist (a provider who specializes in arthritis and other diseases of the joints, muscles, and bones) may fit the bill.